Archive for the ‘Legal’ Category

ObamaCare: One Step Forward, Two Steps Backward

flaD AND STETHISCOPEI have been rather vocal in my opposition to the Affordable Care Act (or ObamaCare). There have been too many problems, too many issues and too many unintended consequences.

According to a report released this week by the non-partisan Congressional Budget Office (CBO), ObamaCare will “reduce the supply of labor by the equivalent of roughly 2.3 million full-time workers through 2021.”

Just as the economy is attempting to recover, we are moving forward with the implementation of a federal healthcare disaster that will kill even more jobs.
There is some good news. There is a new, legitimate “repeal and replace” movement led by US Senators Orrin Hatch (R-Utah), Richard Burr (R-NC) and Dr. Tom Coburn (R-Oklahoma). This “repeal and replace” effort has substance and includes many thoughtful, private sector based reforms and includes some of the provisions of ObamaCare that address access to health coverage.

The new Patient CARE (Choice, Affordability, Responsibility, and …

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The Healthcare Reform Law that Inequitably Treats Healthcare Providers

A recent article published in Modern Healthcare[1] highlights how CMS interpreted a rule within the healthcare reform law that is putting healthcare providers at greater financial risk. To summarize, healthcare providers could incur unreimbursed costs for services delivered to a consumer that has discontinued paying their insurance premium. See below for a detailed description of this scenario.

It appears that the business of delivering healthcare to a community is becoming more financially challenging. When you consider the increasing number of patients looking for care, reimbursement rates declining, no limits on malpractice suits and increasing regulatory burdens, it should be no surprise that in the future we see more healthcare providers filing for bankruptcy, looking for a financial bailout, selling their business, delivering limited services or discontinuing operations.

Here is the scenario that puts healthcare providers at greater financial risk due to CMS’s …

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Defensive Medicine: More Than Just Another Extra X-Ray

med mal 4Defensive medicine occurs when physicians order tests, procedures or consultations of doubtful clinical value in order to protect themselves from costly and frivolous malpractice suits. Doctors detest the very thought of being sued so they find every means possible to avoid litigation.

And that includes ordering numerous unnecessary and expensive tests and procedures.

While not all Georgia physicians practice defensive medicine, the overwhelming majority do. According to a recent survey conducted by Oppenheim Research, 82 percent of Georgia doctors say they perform unnecessary tests, procedures and referral consultations exclusively to avoid a medical malpractice claim.

A 2010 Gallup Poll of physicians found that one-in-four healthcare dollars is spent on defensive medicine. A great deal of money is “wasted” on the practice of defensive medicine. Last year, Georgians were subjected to $14 billion of unnecessary tests, procedures or consultations with little or no clinical or …

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A Case for Improving Mental Health Services in Georgia

One of the outcomes of December’s tragic shooting at Sandy Hook Elementary School is a renewed interest in addressing behavioral health problems.  While the state of Connecticut has yet to release information about the shooter’s mental state, it is clear that he suffered from a mental health breakdown.  Half to two-thirds of spree shooters, like Adam Lanza, were formally diagnosed, hospitalized, or had shown rage, aggression, paranoia and/or delusional thinking prior to their attack.

Yet, horrific acts like that at Sandy Hook don’t mean that people with mental health problems are more likely to be violent.  In fact, experts argue that people with mental illnesses are much more likely to be victims of crime than perpetrators.

Few people realize how commonplace mental health problems are in the United States.  It is estimated that approximately one in four adults and one in five children will be challenged with an identifiable behavioral health disorder every year.  This has …

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States Debating Innovative Approaches to Medical Malpractice Reform

med mal3From Arizona to Florida, state lawmakers are beginning to address medical malpractice reform. Rather than traditional caps on non-economic (so-called “pain and suffering”) damages, states are getting creative about the way they approach medical professional liability litigation reform.

In Arizona, for example, State Rep. Bob Thorpe of Flagstaff has introduced legislation which would require personal injury lawyers to be certified as a “medical malpractice attorney” before they could file suit against a physician or hospital. “The idea is to try to weed out the difference between good, legitimate attorneys that are practicing in the area of medical malpractice … from the ambulance chasers,” he said. Due to the complexity of the issue, Thorpe’s bill would also require that these cases would only be heard by judges who have been through special training in medical malpractice cases.

In Oregon, Gov. John Kitzhaber has taken an active role in trying to reduce healthcare costs in …

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Taxes – Do We Know One When We See One?

As we approach the half-way point of 2012, an important court case that will dramatically affect the healthcare industry is about to be decided. Next month, the United States Supreme Court is scheduled to decide the constitutionality of the Affordable Care Act. The Supreme Court has heard oral arguments on and may decide the following issues:

1) Whether the penalty for noncompliance with the individual mandate is equivalent to a tax.
2) Whether the individual mandate is legal.
3) Whether the individual mandate is illegal, whether the rest of the Affordable Care Act is also illegal or whether it is severable from the individual mandate.
4) Whether Congress illegally required states to expand the Medicaid program.

Unfortunately, due to the various burdens employers and state governments face in complying with the Affordable Care Act, not all of these issues may be decided as soon as we hope. If the Supreme Court determines the penalty for noncompliance with the individual …

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NFIB vs Sebelius: The Supreme Court and ObamaCare

Last month, ObamaCare had its day (or days) in court. The case … NFIB, et.al. vs. Kathleen Sebelius, et.al. will be the most celebrated Supreme Court cases in modern history.

The Supreme Court heard six hours of oral arguments over three days. That is unprecedented.

There are 26 states that are suing the federal government. That is unprecedented.

The Supreme Court’s decision will impact over twenty percent of the US economy. That is unprecedented.

But what happens if the Supreme Court does strike down all or part of ObamaCare? We better have “Plan B” ready to go.

We all know that our healthcare system is broken. However, we can’t all seem to agree on how we reform or transform our healthcare system. Here is my short list of those things that the Congress should consider if the Supreme Court strikes all or part of ObamaCare:

• Make significant changes to the way we litigate medical professional liability cases. Physicians today order too many tests, prescribe unnecessary …

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STRENGTH IN NUMBERS

There’s been a great deal of debate regarding mergers in healthcare. For regional or smaller community hospitals, their viability in many cases may depend heavily on larger economies of scale. What about doctors, physician practices and outpatient centers?  From a lender’s perspective, there is definitely strength in numbers!  

As shrinking reimbursement becomes the 800 pound gorilla for all healthcare providers, we have to look towards improving efficiencies to survive. From throughput and case management to materials management and contract negotiations, providers have to find ways to improve across the board and cut waste within their existing processes. On top of improved efficiencies, they have to continually drive volume growth.   Procedure rooms with the lights off during operating hours at an ASC are critical dollars missed.  On one side of town there’s a patient waiting 3 days or more for a scan and on the other side of town there’s a CT sitting idle. 

Single doctor …

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ObamaCare: More Unintended Consequences

Since its passage, President Obama’s federal health reform has resulted in a series of unintended consequences. Just last week, the Kaiser Family Foundation released a study which indicates that ObamaCare has caused annual family health insurance premiums to increase at a rate three times higher than in 2010.

ObamaCare has created way too many unintended consequences. 

Remember the ObamaCare provision which guaranteed issue of health insurance for children?  It was intended to ensure that kids who were sick or had pre-existing conditions could obtain health coverage. However, the unintended consequence?  Many health insurers made the business decision to no longer offer so-called “children only” health insurance policies and thousands of children no longer have access to coverage in their state.

Remember how federal health reform was supposed to reduce overall costs? When ObamaCare was passed by Congress and signed by President Obama, the price tag was just over $800 billion. …

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Your physician’s business relationships may be hazardous to your health

Consumers today need to take ownership understanding their physician’s motivation when they recommend surgery especially when it entails implantable products for surgical procedures such as a spinal fusion, knee or hip replacement. This motivation may be more than to help address a patient’s medical issue. It may also be a means for the physician to increase their personal income.

There is a growing trend in the healthcare industry that some physicians would not like consumers to know about. This trend is the development of physician owned distributors (PODs).  A physician owned distributor is a medical products supplier to hospitals that is partially owned by a physician or group of physicians. The primary role of the physician owned distributor is to provide products to its physician investors at the hospitals they practice medicine.

An example would be an orthopedic surgeon that performs hip and knee replacement surgery. This surgeon is an investor in the physician owned …

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